Implications of the Hobby Lobby Decision for Those Affected by Chronic Conditions

This past week, social media, as well as just about every “talking head” has weighed in on the Supreme Court’s decision regarding Hobby Lobby. Today’s post discusses implications for those affected by a chronic condition as a result of the ruling, but first a recap of events:

• June 30, 2014: In Burwell v. Hobby Lobby, the Christian owners of the craft store chain challenged the Affordable Care Act’s (ACA) requirement that companies provide contraception coverage to their employees. In Monday’s U.S. Supreme Court decision, the ruling says privately held companies have the right to deny contraception for women if they object on religious grounds. The majority opinion, which none of the court’s female justices joined, claimed that the 1993 Religious Freedom Restoration Act protects the rights of such businesses’ owners to withhold coverage for birth control if they claim it violates their religious beliefs.

• July 1, 2014: The Supreme court ordered all lower courts to rehear any cases where companies had sought to deny coverage for contraception, not just the specific types Hobby Lobby was opposed to.

• July 1, 2014: A group of religious organizations sent a letter to the President saying they wanted exemption from the LGBT (lesbian, gay, bisexual, transgender) hiring order.

If your waiting to see what will be filed in light of Monday’s decision, there is no wait as The Becket Fund, the religious law firm that represented Hobby Lobby in its legal case, lists 49 pending federal cases in which for-profit companies have brought religious objections against the Affordable Care Act (ACA) and an additional 51 cases that involve non profits.

More than 50% of US companies meet the criteria of “privately held,” and some of these are very large companies, so this has the potential to impact many women.

Precedent, which is what our legal system revolves around, looms large here. Has the precedent has been set for challenging other practices, that make good sense medically but certain religious groups find objectionable? Justice Ruth Bader Ginsburg thought so in her dissenting arguments. Is she going over board, as some claim?

On July 2, the New England Journal of Medicine contained a Perspective written by two lawyers and a physician. In the wake of Hobby Lobby, we may anticipate challenges to other medical services that some religions find objectionable, such as vaccinations, infertility treatments, blood transfusions, certain psychiatric treatments, and even hospice care. Hobby Lobby's implications may also extend into civil rights law, with employers asking to “opt out” of laws intended to protect people from employment and housing discrimination based on religion, race, sex, national origin, or pregnancy status. Although the majority deemed these slippery-slope concerns unrealistic, the dissent expressed serious concerns.

Though the decision applies only to closely held, for-profit corporations, it sets a precedent for religious exemptions that could have sweeping implications — and reflects the Supreme Court's great potential impact on U.S. health care. Yet the Court was applying Congress's statute, and Congress could, if it chose, scale back the protection offered to religious objectors — a good reason to share public reactions to the decision with our elected representatives. 

So what does this all mean for people with chronic conditions? First and foremost, be concerned.

The precedent has now been set that a private business can decide what they will or will not pay for when it comes to their employees health care based on their particular religious beliefs and not what has been found medically appropriate. It’s worth noting here that the employee benefit package is part of their pay and not just the company being nice. So if the employee is actually paying for their healthcare, shouldn’t they have the say and not the employer?

In addition to denying health services, the ruling is already being used to justify discrimination against a group of people, namely the LGBT community, as far as employment.

I’d like to believe that the silver lining to this situation is that the country will finally wake up to the fact that employers should not be brokering employee’s health care. A single payer universal health care system is needed, which. could be phased in by lowering the age for Medicare and extending the age of childcare services, until they eventually meet and everyone is covered:

In the mean time,consider the following:

• Contraception has been shown over and over again to be fundamental to women’s health and well being. For women with chronic disease, it can be a lifesaver, so support organizations that work to help women obtain free and affordable contraception.

• Stay connected with your condition specific organization and support their efforts.

• If you have insurance through your employer, do the homework to see if considerations are being made to make changes as a result of Monday’s decision

• As the authors of the New England Journal of Medicine article pointed out “share public reactions”-let your public officials know how you feel about this issue.

• Vote!